PROJECT SUMMARY Early Childhood Caries (ECC) is the most common chronic disease among children. American Indian (AI) children are 4 times more likely to have untreated dental decay than white children. If left untreated, ECC can lead to chronic pain, loss of teeth, poor nutrition, and impaired growth. The proposed study aims to reduce the burden of ECC in two AI communities through an innovative, community based participatory approach. The project will: 1) partner with 2 tribes, the Hopi Tribe (Arizona) and the Crow Tribe (Montana), to conduct a formative assessment on oral health (OH); 2) adapt a ?bundled? best practices OH intervention to be locally and contextually relevant for each of our tribal communities; and 3) conduct a randomized, controlled study to evaluate the impact of the ?bundled? best practices OH intervention (compared to a standard prenatal/postnatal healthy lifestyle intervention) on the reduction of ECC. Community health representatives (CHRs) will be trained to deliver the interventions with pregnant women and follow them until the child?s last exam (24-36 months). The OH intervention will consist of 4 intervention components known to be effective (best practices) in the prevention of ECC: 1) dietary and OH education provided during pregnancy and the postnatal period; 2) OH care of children including the application of fluoride varnish; 3) motivational interviewing with children?s mothers; and 4) patient navigation of existing OH and other social services in each study community, facilitated by CHRs. Caries experience (dmfs) and severity will be compared across both conditions at the 1, 2, and 3- year exams. Mother knowledge, attitudes, and behaviors related to ECC will be also measured for both conditions at pre-test and post-test. Surveys will assess each level of the social ecological model. Individual level domains will include: 1) demographics of mother and baby (pre-test only); 2) dental health of the child to date; 3) mother?s and child?s OH (postnatal); 4) mother?s knowledge, beliefs, and attitudes about best practices in OH; 5) mother?s perception of self-efficacy and susceptibility; and 6) mother?s prenatal health and experiences. Interpersonal level domains will include: 1) current living situation and family support; 2) availability of emotional, informational, and instrumental support; and 3) perceptions of peers? and family members? attitudes toward caregiving and OH. Community level domains will include: 1) tribal identity and related experiences; 2) care coordination, transportation, and access to social and OH services; and 3) perceptions of cultural congruence of CHR interactions and intervention materials. If successful, this community-based approach may prove to be a feasible method for improving OH of AI children and reducing the burden of ECC in many Native communities with limited access to regular dental care.